VBS Camper Registration

2025 VBS: July 28th-August 1st

VBS 2025 – Camper Registration for Children in Kindergarten (Age 4) through Grade 5

"*" indicates required fields

Family Information

Family Last Name*

Registered OLM Parishioner?*

Yes – Family is a registered parishioner at Our Lady of Mercy

No – Family is not a registered parishioner at Our Lady of Mercy

Primary Email*

Primary Cell Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Information – Parent / Guardian

Mother's/Guardian's Name*

First Last

Mother's/Guardian's Mobile Phone*

Mother's/Guardian's Email*

Information – Parent / Guardian 2

Father's/Guardian's Name*

First Last

Father's/Guardian's Mobile Phone*

Father's/Guardian's Email*

Registration for VBS Campers, Kindergarten (Age 4) through Grade 5

Placement of Siblings*

No restrictions on placement of siblings.

Yes, please place my children in the same group.

No, please do NOT place my children in the same group.

Camper Information:*

First Name

Last Name

Nickname

Date of Birth

Age

Grade Entering in Fall

Gender (M/F)

Hit the plus sign (+) to add additional children.

Information, Policies, and Permissions

Confidential Information

To best support you and your child(ren), please let us know of any physical limitations, learning challenges, special needs and/or family circumstances (recent separation, divorce, death or illness). Please contact Mary Jo (331-707-5378) prior to the start of VBS so we may learn how to support you in the care of your child(ren)’s needs and growing faith. Thank you!

GENERAL PERMISSIONS

General Permissions Consent*

I agree to the General Permissions Consent.

I request that my child(ren) be allowed to participate in Vacation Bible School. I hereby release and indemnify Our Lady of Mercy Parish, its staff, volunteers, and the Diocese of Joliet from any and all liability arising from claims of any kind or nature whatsoever from my child’s participation.
I agree on behalf of myself, my heirs, assigns, executors, and personal representatives, to hold harmless and defend Our Lady of Mercy Catholic Church, and the Diocese of Joliet, its officers, directors, agents, employees, or representatives from any and all liability for illness or death arising from or in connection with my participation.

CODE OF BEHAVIOR

Code of Behavior Consent*

Yes, I agree to the Code of Behavior.

I acknowledge that I am representing our diocese/parish during this event, and I will represent us well. I will adhere to all Diocesan Guidelines and display responsible, mature, and respectful behavior in my words, actions, and usages.

Expectations
1. All participants are expected to arrive on time.
2. All participants are expected to demonstrate respect and common courtesy at all times. Inappropriate language/behavior/conduct will not be tolerated.
3. Socializing should always be done in public areas.
4. Dress should reflect the values of modesty and respect, and inscriptions and images on clothing should reflect Christian values.
5. The possession or consumption of any alcoholic beverages is prohibited.
6. The possession of any illegal substances is prohibited and subject to legal action.
7. Smoking, vaping, e-cigarettes, smokeless tobacco, and cannabis in any form are prohibited.
8. Weapons and/or drug paraphernalia are prohibited.

INFRACTION OF THESE RULES CAN MEAN IMMEDIATE DISMISSAL WITH NO REFUND.

I understand and agree to the Code of Behavior. I also understand and agree that at the time of an infraction requiring dismissal, l will be notified and/or I will be responsible for any and all costs related to the participants dismissal from activities and any all costs assessed by local authorities.

VIDEOS, PHOTOS, AND VIRTUAL PLATFORMS

Videos, Photos, and Virtual Platforms Consent*

Yes, I agree to the Video, Photos, and Virtual Platforms Consent.

Videos and/or photos may be taken during this event. This authorization consent constitutes permission to use my child(ren)’s image in video and/or photos which may be used for future promotional efforts including the parish and /or Diocese of Joliet website.

MEDICAL PERMISSION

Medical Permission Consent*

Yes, I agree to the Medical Permission Consent.

I grant permission for the administration of First Aid to my child/children by the people in charge of the event and those transporting my child to and from the event as their judgement deems advisable and to make the necessary referrals to qualified physicians for the treatment of illness or accidents of a more serious nature. I understand I will be promptly notified in the event of any serious illness or accident and prior to any major surgery, except when delay of such communication would endanger life. In the case of a medical emergency, I understand that every effort will be made to contatct the parent/guardian of the participant. In the event that I cannot be reached I hereby give permission to the physicians selected by the adult staff to hospitalize, secure proper treatment for and to order injections, anesthesia or surgery if deemed necessary for my child.

Medical Information

Our Diocese ask for the information below to assure for child(ren) safety when they are in the care of the parish program.

ALLERGIC TO MEDICATIONS:*

Yes. Allergic to medications.

No. Not Allergic to medications.

If YES, please describe student(s)'s medication allergies:*

Please type NA if not applicable.

ALLERGIC TO FOOD:*

Yes. Allergic to food.

No. Not Allergic to food.

If YES, please describe student(s)'s food allergies:*

Please type NA if not applicable.

ALLERGIC TO OTHER*

Please type NA if not applicable.

OTHER CONDITIONS*

Please type NA if not applicable.

Medical Insurance Information

Our Diocese ask for the information below to assure for child safety when they are in the care of the parish program.

Medical Insurance/Policy in the name of:

Medical Insurance Company

Policy/Identification Number

Authorized Physician

Physician Phone Number

EMERGENCY CONTACTS

Contact information for who to call in case of an emergency and unable to contact parents.

Contact 1 – Name*

Contact 1 – Cell Phone*

Contact 1 – Relationship*

Contact 2 – Name*

Contact 2 – Cell Phone*

Contact 2 – Relationship*

VBS Fees

VBS Fee*

Families with 1 child/camper ($75.00)

Families with 2 or more children/campers ($100.00)

After you hit SUBMIT, you will be redirected to the PAYMENT page to make payment by credit/debit card or by PayPal. If you need tuition assistance or would like to submit a check or cash as payment, please contact Karen Schwartz, Family Faith Administrative Assistant, at karens@olmercy.com or 331-707-5369. THANK YOU!

Please Sign Name Electronically Below*

The parties agree that this document may be electronically signed and that the electronic signatures appearing on this document are the same as handwritten signatures for the purposes of validity, enforceability and admissibility. Transmission via email is not encrypted, so if you are concerned about the security of your sensitive information, please print and fax this form, surface mail it or hand deliver it.

VBS Camper Registration

2025 VBS: July 28th-August 1st

VBS 2025 – Camper Registration for Children in Kindergarten (Age 4) through Grade 5

Family Information

Information – Parent / Guardian

Information – Parent / Guardian 2

Registration for VBS Campers, Kindergarten (Age 4) through Grade 5

Information, Policies, and Permissions

GENERAL PERMISSIONS

CODE OF BEHAVIOR

VIDEOS, PHOTOS, AND VIRTUAL PLATFORMS

MEDICAL PERMISSION

Medical Information

Medical Insurance Information

EMERGENCY CONTACTS

VBS Fees

Please click submit when you are finished filling out the form. Thank you!